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Multimodality evaluation of transcatheter structural valve degeneration at long-term follow-up

Alfredo Nunes Ferreira-Neto1, Tania Rodriguez-Gabella1, Leonardo Guimaraes1

  • 1Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.

Revista Espanola De Cardiologia (English Ed.)
|April 13, 2020
PubMed

Insights

Transcatheter heart valve (THV) performance gradually declines over 10 years, with structural valve degeneration (SVD) affecting 30% of patients. Leaflet issues, not valve geometry, were linked to THV SVD.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Medical Imaging

Background:

  • Transcatheter heart valve (THV) replacement is a common procedure for aortic stenosis.
  • Long-term hemodynamic performance and structural valve degeneration (SVD) of THVs require further investigation.

Purpose of the Study:

  • To assess the long-term hemodynamic performance of THVs using serial transthoracic echocardiography (TTE).
  • To determine the incidence, characteristics, and associated factors of THV structural valve degeneration (SVD) over a 10-year period.

Main Methods:

  • A cohort of 212 patients who underwent transcatheter aortic valve replacement (TAVR) with >5 years follow-up were analyzed.
  • Serial TTEs were performed up to 10 years post-procedure to evaluate valve hemodynamics and SVD.
  • SVD was defined based on changes in transvalvular gradient, valve area, and aortic regurgitation severity.

Main Results:

  • Transvalvular mean gradient increased and valve area decreased over time (P<.01).
  • At 8 years, SVD occurred in 30.2% of patients (clinically relevant SVD in 9.3%).
  • Transesophageal echocardiography showed thickened and reduced-mobility leaflets in most SVD cases; THV geometry did not impact SVD.

Conclusions:

  • Gradual hemodynamic deterioration of THVs occurs over a decade, leading to SVD in approximately 30% of patients.
  • Impaired leaflet morphology and mobility are common in SVD, but THV geometry is not a significant factor.
  • Long-term echocardiographic monitoring is crucial for assessing THV durability and detecting SVD.
Abstract

Keywords:
Degeneración estructural de la válvulaEcocardiografía transesofágicaImplante percutáneo de válvula aórticaLong-term follow-upSeguimiento a largo plazoStructural valve degenerationTomografía computarizada con multidetectoresTranscatheter aortic valve replacementTransesophageal echocardiography Multidetector computed tomography

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